Provider Demographics
NPI:1154760122
Name:MINKEL, JEAN L (PT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:L
Last Name:MINKEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5921
Mailing Address - Country:US
Mailing Address - Phone:914-805-5650
Mailing Address - Fax:
Practice Address - Street 1:25 ELM PL
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5355
Practice Address - Country:US
Practice Address - Phone:212-584-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2013-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008801-12251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology